Devoted to the topic of data specification (including data organization, data description, data retrieval and data sharing) in the life sciences and in medicine.

Monday, August 17, 2009

PRECANCERS: 2 Inducing regression in precancers

Precancers are the lesions from which cancers develop. Precancers can be easily treated, and when we eliminate precancers, we eliminate the cancers that would have developed from the precancers. This is the message of my new book, Precancer: The Beginning and the End of Cancer. In today's blog, I thought I'd provide one example, from the recent cancer research literature, of precancer treatment.

Colon cancer is one of the most common cancers of humans, accounting for about 50,000 deaths in the U.S. in 2009 (data from U.S. National Cancer Institute at:

http://www.cancer.gov/cancerinfo/types/colon-and-rectal

Almost all colon cancers arise from colon precancers, called colonic adenomas.

If we could eliminate colon adenomas, we could eliminate virtually all deaths from colon cancer. This is the premise behind colonoscopy (excise the adenomas and avoid the cancers).

A team of scientists from MIT, Mass Genl, Harvard and several other institutions have published a recent article in PNAS (Proceedings of the National Academy of Sciences), on the successful treatment of colon precancers, in a mouse model system.

The investigators noticed that the stroma (the supporting connective tissue) in colon adenomas is infiltrated with mast cells (a blood cell involved in the inflammatory process). When the investigators reduced the mast cell population (in the tumor stroma) in precancerous mouse colon adenomas, many of the adenomas quickly regressed. In a related study, chimeric mice with a genetic deficiency of mast cell formation developed fewer colon adenomas than wild-type mice.

Precancers, unlike cancers, often regress spontaneously. It seems self-evident that it would be easier to treat a lesion that is unstable, and prone to die on its own, than to treat a lesion that has grown into a large, invasive mass, that has dissemminated throughout the body. This paper is one example of how easy it is to modify the growth of precancers and to induce a high rate of precancer regression.

Because treatment was aimed at the non-neoplastic cells in the stroma of the precancer, it is likely that the same treatment that was successful against colon adenomas may be successful against any precancer for which there is a population of mast cells that contribute to precancer progression. The authors discussed the observation that mast cells are found in a variety of human cancers, and, in a note attached to their paper, cited recent work indicating that mast cells have an important role in the development of pancreatic cancer and prostatic cancer.

It is important to begin treatment while neoplasms are stil in their precancer stage. AFTER an invasive cancer has emerged from a precancer, agents that target a sensitive step in precancer development will probably NOT be curative.

When we have candidate precancer treatments (and we do), we should start testing them in human clinical trials. When we learn how to eradicate precancers, we will have learned how to conquer cancer.

related words: precancers, preneoplastic lesions, preneoplasia, ien, intra-epithelial neoplasia, intraepithelial neoplasia, intra-epithelial neoplasm, intraepithelial neoplasm, in situ carcinoma, carcinoma in situ, cis, dcis, din, pin, panin, cin, dysplasia, adenoma, preneoplastic, pre-cancer, pre-cancerous, precancerous
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About Me

Jules Berman received two baccalaureate degrees from MIT; in Mathematics, and in Earth and Planetary Sciences. He received the Ph.D. from Temple University, and the M.D. from the U. of Miami. He received post-doctoral training at NIH and residency training at Geo. Washington U Med Ctr. He is board certified in anatomic pathology and in cytopathology. He served as Chief of Anatomic Pathology, Surgical Pathology and Cytopathology at the Veterans Administration Medical Center in Baltimore, Maryland, where he held joint appointments at the University of Maryland Medical Center and the Johns Hopkins Medical Institutions. In 1998, he became a Medical Officer at the U.S. National Cancer Institute and served as the Program Director for Pathology Informatics in the Institute's Cancer Diagnosis Program. In 2006, Jules Berman was President of the Association for Pathology Informatics. In 2011 he received the Lifetime Achievement Award from the Association for Pathology Informatics. Today, Jules Berman is a free-lance writer. He has first-authored more than 100 articles and 13 book titles in science and medicine.